title: Exercise and type 2 diabetes mellitus: changes in tissue-specific fat distribution and cardiac function.
abstract: OBJECTIVE
  To prospectively assess the effects of an exercise intervention on organ-specific fat accumulation and cardiac function in type 2 diabetes mellitus.
  
  
  METHODS
  Written informed consent was obtained from all participants, and the study protocol was approved by the medical ethics committee. The study followed 12 patients with type 2 diabetes mellitus (seven men; mean age, 46 years ± 2 [standard error]) before and after 6 months of moderate-intensity exercise, followed by a high-altitude trekking expedition with exercise of long duration. Abdominal, epicardial, and paracardial fat volume were measured by using magnetic resonance (MR) imaging. Cardiac function was quantified with cardiac MR, and images were analyzed by a researcher who was supervised by a senior researcher (4 and 21 years of respective experience in cardiac MR). Hepatic, myocardial, and intramyocellular triglyceride (TG) content relative to water were measured with proton MR spectroscopy at 1.5 and 7 T. Two-tailed paired t tests were used for statistical analysis.
  
  
  RESULTS
  Exercise reduced visceral abdominal fat volume from 348 mL ± 57 to 219 mL ± 33 (P < .01), and subcutaneous abdominal fat volume remained unchanged (P = .9). Exercise decreased hepatic TG content from 6.8% ± 2.3 to 4.6% ± 1.6 (P < .01) and paracardial fat volume from 4.6 mL ± 0.9 to 3.7 mL ± 0.8 (P = .02). Exercise did not change epicardial fat volume (P = .9), myocardial TG content (P = .9), intramyocellular lipid content (P = .3), or cardiac function (P = .5).
  
  
  CONCLUSIONS
  A 6-month exercise intervention in type 2 diabetes mellitus decreased hepatic TG content and visceral abdominal and paracardial fat volume, which are associated with increased cardiovascular risk, but cardiac function was unaffected. Tissue-specific exercise-induced changes in body fat distribution in type 2 diabetes mellitus were demonstrated in this study.
authors.affiliation: Departments of Endocrinology and Metabolism, Radiology, and Nephrology, Leiden University Medical Center, C3-R, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Department of Cardiology, Tjongerschans Hospital, Heerenveen, the Netherlands; Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jacqueline T
authors.initials: JT
authors.lastname: Jonker
authors.forename: Pieter
authors.initials: P
authors.lastname: de Mol
authors.forename: Suzanna T
authors.initials: ST
authors.lastname: de Vries
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Widya
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Hammer
authors.forename: Linda D
authors.initials: LD
authors.lastname: van Schinkel
authors.forename: Rutger W
authors.initials: RW
authors.lastname: van der Meer
authors.forename: Rijk O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Webb
authors.forename: Hermien E
authors.initials: HE
authors.lastname: Kan
authors.forename: Eelco J P
authors.initials: EJ
authors.lastname: de Koning
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D050152:Intra-Abdominal Fat / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000032:analysis
chemical_list: D014280:Triglycerides